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Couseling Notes 2010
School of Social Work, Marian College
Kuttikkanam
Counseling Notes Counseling Introduction
Session 1
Definitions
Counseling is an interactive processconjoining the counselee who needsassistance and the counselor who is
assistance
Perez,1965
Counseling is that interaction which
Occurs between two individuals calledcounselor and client
Is initiated and maintained to facilitatechanges in the behavior of client
Pepinsky & Pepinsky (1954)
Process involving interpersonal
relationships between a therapist and oneor more clients by which the former
systematic knowledge of the human
personality in attempting to improvemental health of the latter
Patterson (1959)
Counseling is a process by which the
structure of the self is relaxed in the safetyof the clients relationship with the
,experiences are perceived and then
integrated into an altered self Rogers (1952)
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Counseling is a learning oriented process, carried on ina simple, one to one social environment, in which the
counselor, professionally competent in relevantpsychological skills and knowledge, seeks to assist theclient by methods appropriate to latter's needs and within
,how to put such understanding into effect in relation tomore clearly perceived, realistically defined goals to theend that the client may become happier and moreproductive member of society Gustad (1953
Psychotherapy: Definition
Psychotherapy is a set of techniques intended to
cure or improve psychological and behavioralproblems in humans. The commonest form ofpsychotherapy is direct personal contactbetween therapist and patient, mainly in the formof talking. Because sensitive topics are oftendiscussed during psychotherapy, therapists areexpected, and usually legally bound, to respectpatient privacy and client confidentiality.
Psychotherapy is term used to describe a varietyof different talking therapies used to treatpsychological disorders. Psychotherapy involvestalking to a licensed professional during ascheduled series of appointments. It has provento be effective in treating different psychologicaldisorders, and can be combined with drugtherapy to treat all degrees of disorders.
A treatment by psychological means, of problemsof an emotional nature in which a trained personestablishes a professional relationship with thepatient with the object of (1) removing,
, ,mediating disturbed patterns of behavior, and (3)promoting positive personality growth anddevelopment. (Wolber, The Technique ofPsychotherapy, 1977).
Psychotherapy is a set of techniques used totreat mental health and emotional problems andsome psychiatric disorders. It helps the person
to understand and accept their strengths andweaknesses, as well as what makes them feelpositive or anxious. Identifying feelings and waysof thinking helps the person to cope withsituations they find difficult, and new ways ofapproaching them.
Psychotherapy is often used to deal with psychologicalproblems that have built up over a number of years. Thisrequires a trusting relationship between the person andthe psychotherapist, and treatment usually lasts for
months or sometimes years. Psychotherapy may becarre ou on an n v ua as s, as par o a group orwith your spouse or partner. Sessions are normallyhourly, each week or fortnight.
Psychotherapy is sometimes referred to as a 'talkingtreatment', as it is often based on talking to a therapist ora group of people who have similar problems.
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School of Social Work, Marian College
Kuttikkanam
Counseling and PsychotherapyCounselingCounseling PsychotherapyPsychotherapy
Counselors,
pastoral couns,couns psycholo etc.
Practiced by psychiatrist, Clinical
Psychologist and Psy. Social Worker
Aims at better Aims at creating personalitypersonal adj. change/restructuring personality
Often for treatment
Shorter duration Longer in duration and number ofsessions
Practiced indifferent settings
Mostly in medical/clinical setting
Counseling and Psychotherapy
Similarities: uses Similar approaches and techniques
Objective for assisting clients
Further reading:Rao, S.N. (2002). Counselling and Guidance. New Delhi: Tata Mc
Graw Hill Publishing Company Ltd. pp. 24-32
SIMILARITIES &
DIFFERENCES INCOUNSELING &
Characterized byCharacterized bywords likewords like
EDUCATIONALEDUCATIONAL
PREVENTIVEPREVENTIVE Characterized by wordsCharacterized by words
--
PROBLEMPROBLEM--SOLVINGSOLVING
RECONSTRUCTIVERECONSTRUCTIVE
SEVERE EMOTIONALSEVERE EMOTIONALPROBLEMSPROBLEMS
REMEDIATIONREMEDIATION
LONGLONG--TERMTERM
EVERYDAY NORMALEVERYDAY NORMALPROBLEMS LIKEPROBLEMS LIKE
ADJUSTMENTSADJUSTMENTS
SCHOOL ANDSCHOOL AND
Characterized byCharacterized bywords likewords like
PROBLEMSPROBLEMS
Terms:Terms:
COUNSELORCOUNSELOR
CLIENTCLIENT
DYSFUNCTIONSDYSFUNCTIONS
CLINICAL PROBLEMSCLINICAL PROBLEMS
PATIENTPATIENT
THERAPISTTHERAPIST
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Kuttikkanam
DIFFERENCES AND SIMILA RITIESGUIDANCE & COUNSELING PSYCHOTHERAPY
1. Concentrates on
helping normal
individual
1. People with
emotional,
Psychologicaldisturbance
2. To assist young
people with adjustment
problem
2. With behavioral/
mental disorder
(psychogenic origin)
3. Concerns withvocational areas,academic problems,interpersonal,educational, marital,personal, and socialadjustments
3. With total personalitystructure
G U I D A N C E & C O U N S E L I N G PSYCHOTHERAPY
4. Helps the person toadjust to a situation
5. A Relationship toimprove restoreadjustments orfunctioning
4. PsychologicalProcedures,Psychoanalysis,Play Therapy,BehaviorModification
Counselors:* Give, interpret psy
tests, interview,observe
* Offer practicalapproaches in
Psychotherapists:*Treat specific
mental or emotionaldisorder
*Usually apsychiatrist,
resolving a problem
* Mostly in schools
* Not necessarilytrained in doctoral
level
clinical psychologist
*Trained underdoctoral level orPost-Doctoral
Counse l ing & Psychot herapy* Respect Clients as unique / worthyindividual, right to freedom of choice and
to self-determination
* No coercion / pressure
* Help person to take responsibility,restore self-esteem and functioning
Psychiatry
1. Psychiatry: The medical specialtyconcerned with the prevention,diagnosis, and treatment of mental
.
2. The branch of medicine that deals withthe diagnosis, treatment, and preventionof mental and emotional disorders.
Guidance
Assistance given to individuals in makingintelligent choices and adjustments
Makes people self dependent and self
directed through romotng ut zat on o ones own potenta
Performs a complimentary educationalfunction, assisting normal developmentand personal autonomy
Applied in educational systems
Ref: Rao, S.N. (2002). Counselling and Guidance. New Delhi: Tata Mc Graw Hill PublishingCompany Ltd. pp. 34-39
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Kuttikkanam
Counseling Process
Session 2&3
Process -ARPIE
Fuster, J. M. (2002).Personal Counselling.
Mumbai: BetterYourself Books.
Preparatory Stage: Attending
First Stage: Responding
Second Stage: Personalizing
Third stage: Initiating
Subsequent Stage: Evaluating
Preparatory Stage: Attending
AttitudesAttitudes SkillsSkills
RespectGenuinenessEmpathy
Social skillsAttendingPhysicallyObservingListening
First Stage: Responding
Attitudes
Respect
Genuineness
Empathy
Skills
Responding to content
Responding to feeling
Responding to questions
Concreteness
Self Disclosure
Making summaryresponses
End the stage with a neatsummary of the dominantfeeling and their reasonsand get it checked by the
counselee
Attitudes
All of first stage
Confrontation
Skills
Personalizing theproblem and goal
together
Second Stage: Personalizing
Third stage: Initiating
Attitudes
All the above
Skills
State the goal clearly
Identify appropriate
steps to reach the goal Formulate the first
step
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Kuttikkanam
Subsequent Stage:Evaluating
Attitudes
All the above
Skills
Evaluate afterimplementation andmodify plan of actionbased on feedback
Sustain motivation
Phases of Counseling
Relationship building Phase
Exploration and understanding phase Problem Solving Phase
Termination and Evaluation Phase
Yeo,Anthony.(1993). Counselling a Problem Solving Approach. Boa Vista: APECA publications inIndia.
Problem Solving Steps
Problem definition
Attempted Solutions
Desired changes
Intervention plan
Yeo,Anthony.(1993) pp.107-148
Five Stage Model
1. Preparation
2. Assessment
3. Contracting
4. Engaging
5. Terminating
Adapted fromCarroll, Michael.,(1996). Workplace Counseling: As systematic Approach to Employee
Care.London: Sage Publications. pp 102-137
A Problem Solving Approach toCounseling (Five-Stage Model)
Five Stage Model
Steps in Counseling Process
Stage 1: Awareness of need for help
Stage 2: Relationship building
Stage 3: Expression of feelings &Clarification of problem
Stage 4: Exploration of deeper feelings
Stage5: Synthesis &Integration client
potentialities and direction ofneeds to goals
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Kuttikkanam
Stage 6:Focusing on the present and
understanding the past Stage 7: Awareness/insight of the problem
Stage 8:Generalising gains to the day today life
Rao, S.N. (2002). Counselling and Guidance. New Delhi: Tata Mc Graw HillPublishing Company Ltd pp.122-124
STAGE ONE
Forming rapport and gaining the students
trust Assuring confidentiality and discussing
Allowing ventilation
Allowing expression of feelings
1
Exploring the problems), asking the clientto tell her story
Clarifying client expectations of counseling
1
Describing what the counsellors can offerand their method of working
Statement from the counsellor about their
STAGE TWO
Definition and understanding of roles,boundaries and needs
xp a n ng ro es an oun ar es o e
counselling relationship
Establishing and clarifying client goals andneeds
2
Prioritizing client goals and needs
Detailed history taking telling the story inspecific detail
Exploring client beliefs, knowledge andconcerns
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STAGE THREE
Process of ongoing supportive counseling
Continued expression of thoughts andfeelings
Identifying options
Identifying existing coping skills
3
Development of further coping skills
Evaluating options and their implications Enabling behaviour change
Supporting and sustaining work on clientproblems
3
Monitoring progress towards identifiedgoals
Altering plans as required
Referral as appropriate
STAGE FOUR4
Closure or ending the counsellingrelationship
Client acting upon plans
Client managing and coping with daily
functioning
Existence of a support system andsupports being accessed
4
Identification of strategies for maintenance
of change
Closure discussed and planned
Appointment intervals lengthened
4
Available resources and referrals identified
and accessed
Assurance provided to the client of the
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Kuttikkanam
THE GATHER STEPS
G Greet clients in an open, respectfulmanner. Give them full attention. Talk in a
private place if possible. Assure the client ofconfidentiality. Ask the client how you can help,and explain what the clinic can offer in response.
A Ask clients about themselves. Payattention to what clients express with their wordsandtheir gestures and expressions. Try to putyourself in the clients place. Express yourunderstanding. Find out the clients knowledge,needs, and concerns so you can respondhelpfully.
T Tell clients about choices.
H Help clients make an informedchoice. Help the client think about what
situation and plans. Encourage the clientto express opinions and ask questions.Respond fully and openly.
E Explain fully how to use thechosen method.
R Return visits should be welcomed.
return for follow-up & always invite theclient to come back any time for any
reason.
Factors influencing Counselingprocess
Counselor variables
National Vocational GuidanceAssoc.
Interest in people
Patience Sensitiveness
Hamrin & Paulson
Understanding Sympathetic attitude
Friendliness
Sense of humor Stabil it y
mot ona sta ty Objectivity
Patience
Objectivity
Sincer ity Tact
Fa irness Tolerance
Neatness calmness
Mowrer(1951)
Personal maturity
Counselling Skills
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Kuttikkanam
Counseling Introduction
Role Play 1
Team of three Counselor, counselee, observer
ocus on e eg nnng o e counse nginterview (first session)
Ask
the counselor put the client at ease?
the counselor introduced herself? the counselor assured confidentiality and
discussing limits of confidentiality
The Counselor Allowed free expression of theproblem/ask the client to tell her story
The counselor allowed expression of feelings
Clarifying client expectations of counseling
Rate : Excellent (5)- Poor (0)
Role Play 2nonverbal skills
Team of three
Counselor, counselee, observer
Focus on the nonverbal communication of thecounselin interview
SOFTEN
Smiling
Open Posture
Forward Lean
Touching
Eye to eye contact
Nodding
Verbal following skills
Furthering
Paraphrasing
Closed ended and open ended questions Seeking concreteness
Providing and maintaining focus
summarizing
Furthering
Minimal prompts I see, yes, then what
etc
Accent responses repeating certain
tone
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Paraphrasing
Use fresh words to restate the clients
message concisely
Seeking concreteness
Clients tends to generalize issues
Making the clients responses specific Used for
Clarifying the meaning of vague or unfamiliarterms
Explore basis of conclusions drawn by clients
Help to personalize statements
Elicit specific feelings
Explore details
Importance of verbal and nonverbalcommunication
Nonverbal communication
ys ca atten ng
Nonverbal communication facialexpression
Desirable
Direct eye to eye contact
Warmth and concernreflected in facial
Undesirable
Avoidance of eye contact
Eye level above or lowerthan the clients
expresson
Eyes at same level asclients
Appropriate facialexpressions
Occasional smiles
Lifting eyebrow critically
Nodding headexcessively
Frozen or rigid facialexpressions
Inappropriate slight smile
Pursing or biting lips
Nonverbal communication posture
Desirable
Arms and handsmoderately expressive,appropriate gestures
Body leaning slightly
Undesirable
Rigid body posture, armstightly folded
Body turned at an angle
to clientforward, attentive butrelaxed
Fidgeting with hands
Squirming or rocking inthe chair
Slouching or placing feeton desk
Hand or fingers overmouth
Pointing finger foremphasis
Nonverbal communication voice
Desirable
Clearly audible but notloud
Warmth in tone of voice
Undesirable
Mumbling or speakinginaudibly
Monotonic voice
Voices modulated toreflect nuances of feelingand emotional tone ofclients messages
Moderate speech tempo
Halting speech
Prolonged silences
Excessively animatedspeech
Slow or rapid speech
Consistent clearing ofthroat
Speaking loudly
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Nonverbal communication physical proximity
Desirable
3-5 feet betweenchairs
Undesirable
Excessive closenessor distance
Role Play 3Listening skills
Team of three
Counselor, counselee, observer Focus on the listening and summarizing
SOLER
Sit Squarely
Open posture
Leaning forward
Etec
Relaxed
Empathy
Very good empathic response
Good
Moderate
Slight
No empathy
Situation 1
Woman to marital conselor
I cant make up my mind whether to get divorc or not.There are so many things to consider. Also I am scared ofbeing my own
Counselor Responsea e , ow ong you een marre an are t ere any c reninvolved
b) Youre undecided about divorce since there are so manyangles, including yours fears of being alone
c) Youre too frightened to get divorced at the moment
Situation 2
My firm is making me redundant. Im 45 andshould be at the height of my career. It reallyhurts
ResponseA) youre angry at the way you are treated
B) youre wallowing at self pity at this moment
C) youre in a lot of pain because you have beenmade redundant when you should be at yourpeak
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Situation 3
When things get on top of me I get this craving.Its like I simply must have a fix to get somehappiness and relief
Response
) av ng a x s your way o cop ng w t psy pa n
B) you feel compelled to have a fix when life getstoo much for you
C) when you feel vulnerable and overwhelmeddrugs seem the only way out
Restating content
My husband was a fine man.His
unexpected death was a great shock. I stillmiss him terribly
Restating content 2
My mother says do this. father says dothat. I really dont know where I stand
The professional ethics to beheld in counseling
1.Confidentiality
2.Respecting the right of Privacy
3.Respecting the gender identity of the Client
4. Respecting the Profession
5. Acce tin the Client
6. Unnecessary probing
7. An appropriate time and place
8. Prolonging the counseling sessions
9. Respecting the freedom
10.Unnecessary dependency
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Dual relationships
Guidelines for ethical and legalpractice
Aware of own needs how needs influence
clients Should have training and experience
Res onsibilit for a ro riate stands in ethicaldilemma
Theoretical framework of behavior change
Client is primary
Continuous learning and updated knowledge
Discuss limits of confidentiality
Know boundaries of competence
Should become models Rational Emotive therapy
RET/REBT
Proposed by Albert Ellis
Emphasized the role of thinking in humanbehavior
Basic Concepts
Propositions
People are born with a potential to be rational(self constructive) as well as irrational (self
destructive Peoples tendency to irrational thinking ,self
damaging habituations wishful thinking areformed from their culture and families
Humans perceive, think, emote and behavesimultaneously
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RET do not believe in warm relationships as
necessary condition for making change ratherbelieve in active directive therapeutic process
Uses variety of techniques such as role playing,assertion training, desensitization, humor,suggestion etc.
RET asserts that insights often do not lead tomajor personality change
RET think beyond the S- R ideology
ABC Concept Ellis (1989)
Activating Event Belief Consequence
Disputing Effect New Feeling
Therapy process
Goal: decrease clients self defeatingoutlook and to acquire more realistic,
tolerant hiloso h of life
Therapist uses a rationalizationapproach in assisting the client
Techniques
Continuum used for assessing theemotions and feelings of the client ( help inestablishing a baseline)
Personal discovery challenges the clientto do selected self help exercises thathelp achieve deep seated cognitivechange
Self Exploration
REBT self help form
Positive Self talk Triple column technique
Automatic thought
Cognitive distortion
Rational response
Humor
Confronting
Unconditional positive self- regard
Forceful coping statements Analogies and images
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Rational Self Analysis
Client Centered Therapy
Client Centered Therapy
Proposed by Carl R Rogers (1902-1987)
Based on humanistic view
Also called human centered therapy
Central Concepts
The growth potential of any individual willtend to be released in which the helpingperson is experiencing and communicating
, ,nonjudgmental understanding
Central Concepts
IT - THEN hypothesis
IF certain conditions are present in theattitudes of the person designated therapist in
a relationshi namel con ruence ositiveregard, and empathetic understanding, THENgrowthful change will take place in the persondesignated client
Basic Concepts
Inner resources of client could be brought
out through basic optimism
( belief that individuals know their need and
True understanding of clients subjectiveexperiences
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Trust in the constructive directional flow
toward the realization of each individualspotential
Necessary core conditions for facilitating
client growth and change Empathy
Warm regard
Accepting the clients world as the clientperceives and values it-
reduces the resistance of the client and
encoura es ersonal rowth
provides positive sense of self worth and, personaldirection and
a capacity to take personal risks
Self Concept persons perceptions andfeelings about self ( Rogerian Therapy Focuses onaltering the self concept)
Incongruence between self andexperience ( (private world of the individual )
The nature of relationship is viewed as thekey element in creating positive change
Therapy Process
Conditions for the therapy to occur
The client and therapist should be in psychologicalcontact
The client must be experiencing some anxiety,vulnerability or incongruence
The client must receive the or experience theconditions offered by the therapist
The therapist must create a nonthreateningatmosphere of acceptance and genuine caring
The therapists role is NONDIRECTIVE
Techniques
Empathy
Congruence consistency in thought andbehavior transparent, authentic,
genu ne and honest Warm regard/Positive regard
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Techniques Contd.
Setting the therapeutic environment
Confirmation of confidentiality Consent
Active listening
Reflection
Restate content
Characteristics of a fullyfunctioning Person
Openness to all experiences
No defenses used to distort experiences Self concept congruent with experiences
Unconditional positive regard for themselves
Enjoys others because of reciprocal positiveregard
Socially effective and approved by significantothers
Adlerian Therapy
Corey,Gerald.(1986).Theory and Practice of Counseling andPsychotherapy. California: Brooks/Cole Publishing House
Adlerian Therapy Focus
Importance of the feelings of self (ego)that arise form interactions & conflicts
Sense of self(ego) central core of
Ego = core individuality of person
Start from Psychoanalysis
Emphasis on motivation & socialinteraction
Alfred Adlers IndividualPsychology
A phenomenological approach-subjectiveperception of reality
Personality as a unity, an invisible whole Behavior purposeful and goal directed - - Birth order and sibling relationships Therapy as teaching, informing and
encouraging Basic mistakes in the clients private logic The therapeutic relationship a collaborative
partnership
Adlers IndividualPsychology
Based on the unique motivations ofindividuals
Importance of each persons perceived
niche in society Importance of goal directness of human
nature teleological aspect
Concern with social conditions-need totake preventive measures to avoiddisturbances in personality
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The PhenomenologicalApproach
Adlerians attempt to view the world from
the clients subjective frame of reference How life is in reality is less important than howthe individual believes life to be
It is not the childhood experiences that arecrucial ~ It is our present interpretation ofthese events
Unconscious instincts and our past do notdetermine our behavior
Social Interest
Adlers most significant and distinctive concept
Refers to an individuals attitude toward andawareness of being a part of the humancommunity
Mental health is measured by the degree towhich we successfully share with others and areconcerned with their welfare
Happiness and success are largely related tosocial connectedness
Role of Birth Order
Motivates later behavior:
First-born: favored, only, pseudo-parent-high achievers
Second-born: rivalry & competition
Last-born: more pampered, baby-creative, rebellious, revolutionary, avant-garde
Birth Order
Adlers five psychological positions:
1. Oldest child ~ receives more attention,spoiled,center of attention
2. econ o on y two ~ e aves as n arace, often opposite to first child
3. Middle ~ often feels squeezed out
4. Youngest ~ the baby
5. Only ~ does not learn to share or cooperatewith other children, learns to deal with adults
Encouragement
Encouragement is the most powerfulmethod available for changing a personsbeliefs
Hel s build self-confidence and stimulatescourage
Discouragement is the basic condition thatprevents people from functioning
Clients are encouraged to recognize thatthey have the power to choose and to actdifferently
Complexes
Inferiority Complex: normal feelings ofincompetence and exaggerates them-impossible to to achieve goals-hopeless
Superiority Complex: very high opinionof self-bragging and quick to arguepersonal solutions to problems are rightone-convince others of being valuable tothem and to self
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Other Adler Concepts
Organ Inferiority: everyone is born
with some physical weakness-motivate life choices
Aggression Drive: reaction toperceived helplessness orinferiority-lashing out against theinability to achieve or master
More Adler Concepts
Masculine protest: Kids work to becomeindependent from and = adults & people
in power-autonomous-positive assertive
Perfection striving: people who are notneuro ca y oun o an n er or ycomplex spend their lives trying to meettheir fictional goals.
Elimination of their perceived flaws
as if philosophy
Gives motivation and focus
More Adler Concepts
Social Responsibility &Understanding-social issues
Occupational tasks-career-self-worth
Societal task-creating friendships-ne wor s
Love tasks-life partner
Positive & Goal Oriented Humanity-people striving to overcome weaknessesto function productively-contributing tosociety
Adlers PersonalityTypology
Adlers Types GreekHumors
Greek Types SocialInterest
Activity
Ruling-Dominant Yellow Bile Cholericirritable
Low High
Getting-Learning Phlegm PhlegmaticLethargic
Low Low
Avoiding Black Bile Melancholicbrooding
Very Low Low
Socially Useful Blood Sanguinecheerful
High High
How an Adlerian does Therapy
Comprehensive Assessment using: Family Constellation-questionnaire-social
world assessment
Early Reflections-single incidents fromchildhood
Lifestyle Assessment-develop targets fortherapy by identifying major successes andmistakes in the clients life
What Clients do in Therapy
Explore private logic-concepts about self,
others, & life philosophy lifestyle isbased
symptoms and basic mistakes associatedwith their coping
Learning how to correct faultyassumptions & conclusions
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Client Therapist Relationship
Relationship based on mutual trust,
respect, confidence, & alignment of goals Collaborative relationship
Develop a therapeutic contract-goals for
therapy
Emphasis of responsibility of client for hisor her own behaviors
Therapeutic Techniques &Procedures
Establishing the Relationship
Exploring the psychological dynamicsoperating in the client-assessment
Encouraging development of self-
understanding-insight into purpose
Helping client make new choices-reorientation & reeducation
1. Establishing Relationship
Therapist get to know the client as aperson
Collaborate on goals for therapy
uppor ve erap s -car ng umanconnection
Therapist works to make client feel deeplyunderstood and accepted
Client focuses on what needs to changed
in therapy
2. Exploring IndividualsDynamics
Subjective interview Client tells own story as expert on own life
Therapist listens for clues to clients coping andapproach to life
,what would you do differently, if you did not have thissymptom or problem?
Objective interview ~ Life Style Assessment Family constellation
Early Recollections
Personality Priorities
Integration and Summary
3. Encouraging Self-Understanding & Insight
Insight = understanding of motivations thatoperate in clients life
Client-disclosure & Therapist-interpretation
Therapist interpretations offered in open-endedmanner to: Make unconscious process conscious
Confront resistance so to help client & therapist toalign
Explore purposes of symptoms, feelings, behaviors &human difficulties or blocks
4. Helping with Reorientation &Reeducation
Encouragement process to build
courage to change to overcomediscouragement-personal growth is
Change and search for new possibilities
Making a difference-through change in
behavior, attitude or perception
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Where Adlerian Approaches areApplied
Education
Parent Education-Children the Challenge-Rudolph Dreikurs & Soltz, 1964
Marriage Counseling
Family Counseling
Group Work
Reality Therapy
Introduction
William Glasser
Individuals are responsible for theirbehavior
Therapy aim at creating more responsible
behavior
Basic needs
Power (which includes achievement and feelingworthwhile as well as winning).
Love & Belonging (this includes groups as wellas families or loved ones).
Freedom (includes independence, autonomy,your own 'space').
Fun (includes pleasure and enjoyment).
Survival (includes nourishment, shelter, sex).
Behavior is for fulfilling these needsBehavior is for fulfilling these needs
Characteristics
Existential-phenomenological orientation People are moved by inner forces
Perceive world in the background of our needs
Behavior is the result of choices
Control theory All living organisms constantly act to control the world
around them acco. to some purpose within them
Behavior is the control of our perceptions
Concepts
Rejection of the medical model Neurosis and psychosis as behaviors
attempted to control the external world
Success Identit and ositive addiction Persons with success identity have strengths
Positive addiction as psychological strength
Emphasis on responsibility
De-emphasis on exploration of past
De-emphasis on transference
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Therapeutic Process
Helping individuals to be emotionally
strong Helps individuals to achieve autonomy
GOALS OF REALITY THERAPY
The basic goal of reality therapy is to help
individuals meet their psychological needsfor belonging, power, freedom, and fun.
These goals are met in such a way thatthey do not infringe on the needs ofothers.
The focus is on responsibility and choices.
Therapist Roles
Focus on clients strengths, attributes, andpotentials that can lead to success
Pinning down
Confrontation
Therapeutic Techniques andProcedures
Assist client to develop a success identity1. Create a relationship
2. Focus on current behavior
3. Invite clients to evaluate their behavior
4. Help clients to develop an action plan
5. Get commitment
6. Refuse to accept excuses
7. Refuse to use punishment
8. Refuse to give up
Action Plan
Simple and clear
Short and able to be broken into smallunits
Something the client will do
Dependent on what the client does
Specific, what, when, where, how often
Repetitive, daily
immediate
REALITY THERAPYSTRATEGIES
Reality therapists do not emphasize specific techniques. However, they are more likely to use some techniques than
others. Because of the focus on exploring and evaluating behavior,
reality therapists are likely to ask many questions.
when talking to clients. Because much of reality therapy focuses on making plans and
commitment to them, using humor and being positive can behelpful in encouraging clients.
Confrontation helps therapists deal with clients when they donot follow up on plans.
Paradoxical techniques are ways to help clients when they maybe resistant to carrying out plans.
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QUESTIONING
Questions can be used to help clients
explore their wants, needs, andperceptions.
They are also good approaches tounderstanding how the client thinks, togather information, to giving informationand making sure its understood, and inhelping clients take more effective control.
BEING POSITIVE
Reality therapists take many opportunities toreinforce the constructive planning of theirclients and their success in following through onthe plans.
Reality therapists may turn negative occurrencesinto positive ones by taking advantage ofopportunities to communicate hope to clients.
METAPHORS
When clients talk, they sometimes usemetaphors such as When I got caught,the whole world fell apart.
Therapists listen to those metaphors andrespond to the metaphor such as, Whathappened when the world fell apart?
HUMOR
Because humor is spontaneous andidiosyncratic, it can only occur at themoment so that it can fit in naturally.
Humor is a part of friendly involvement astherapists can sometimes laugh atthemselves which encourages clients todo the same.
CONFRONTATION
When clients dont follow through on
plans, confrontation is unavoidable.
Not accepting excuses, being positive, andusing humor can be ways of confrontingclients.
PARADOXICAL TECHNIQUES
When clients are reluctant to carry out plans or resistmaking plans, sometimes paradoxical techniques can beused.
They are among the most difficult techniques for- .
Reframing the way clients think about a topic can helpthem believe a previously undesirable behavior isdesirable. (like spitting in the clients soup)
Another paradoxical technique is to prescribe a symptomsuch as telling an anxious person to schedule timeswhen they are anxious.
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ProcedureWDEP- Robert Wubbolding
W = Want
D = Direction and DoingE = Evaluation
P = Planning
W = Want
Clarify clients wants: their quality worldQuestions:
What do you want that you are getting?
What do you want that you are not getting?
How will you know whether you are getting it or
not?
D = Direction and Doing
Overall direction and specific actions that
occurred recently
Questions:
Where are you heading?
What are your recent successes? Recent
challenges?
What have you tried so far?
E = Evaluation
Getting clients to evaluate their behavior
Questions
Is what you are doing helping you?
Is it working?
P = Planning
Characteristics of good plans: SAMIC
S = Simple A = Attainable
M = Measurable
I = Immediate
C = Controllable
Existential Therapy
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Existential Therapy
Defined as an attitude that transcends
orientation (May, Angel, & Ellenberger,1958), a dynamic therapy that addresses
, ,
practically any antideterministicpsychotherapy (Edwards, 1982)
Existential Therapy Is a diffuse school of theorists and
practitioners more aligned in their
philosophical emphasis than in technique orpractical consequences
More of a philosophy of therapy than asystem of therapy.
Many American clinicians have assembledthe many strands of the philosophy into acoherent clinical approach (Rollo May, JamesBugental and Irving Yalom)
Existential TherapyPhilosophical/Intellectual Approach to Therapy
BASIC DIMENSIONS ~ OF THE HUMANCONDITION
The capacity for self-awareness
The tension between freedom & responsibility
The creation of an identity & establishingmeaningful relationships
The search for meaning
Accepting anxiety as a condition of living
The awareness of death and nonbeing
The Capacity for Self-Awareness
The greater our awareness, the greater ourpossibilities for freedom
Awareness is realizing that:
We are finite - time is limited
We have the potential, the choice, to act ornot to act
Meaning is not automatic - we must seek it
We are subject to loneliness,meaninglessness, emptiness, guilt, andisolation
Freedom and Responsibility
People are free to choose among
alternatives and have a large role inshaping personal destinies
become are result of our choices
People must accept responsibility for
directing their own lives
Identity and Relationship
Identity is the courage to be ~ We must trust ourselvesto search within and find our own answers
Our great fear is that we will discover that there is nocore, no self
Aloneness ~ we must tolerate being alone with self-musthave a relationship with self
Struggling with identity-trapped in doingmode to avoidexperience of being
Relatedness ~ At their best our relationships are basedon our desire for fulfillment, not our deprivation
Relationships that spring from our sense ofdeprivation are clinging, parasitic, and symbiotic
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The Search for Meaning
Meaning ~ like pleasure, meaning must bepursued obliquely
Finding meaning in life is a by-product of acommitment to creating, loving, and working
e w to mean ng s our pr mary str v ng
Life is not meaningful in itself; the individualmust create and discover meaning
Goals deal with
Discarding old values
Coping with Meaninglessness
Creating new meaning
Anxiety A Condition of Living
Anxiety-arises from strivings to survive &maintain own being
Existential anxiety is normal - life cannot belived, nor can death be faced, without anxiety
nxety can e a st muus or growt as webecome aware of and accept our freedom
We can blunt our anxiety by creating theillusion that there is security in life
If we have the courage to face ourselves andlife we may be frightened, but we will be ableto change
Awareness of Death &Nonbeing
Awareness of death is a basic humancondition which gives significance to living
We must think about death if we are tothink si nificantl about life
If we defend against death our lives canbecome insipid & meaningless
We learn to live in the now, one day at atime-results in zest for life & creativity
Ultimate Concerns
1. Freedom
2. Death
3. Isolation
4. Meaninglessness
Goals of Existential Therapy
1. Help clients be more aware of themselves
2. Face defense mechanisms3. Engage in action that is based on the
authentic purpose of creating a worthyexistence.
Existential TherapeuticTechniques
1) Write their eulogy
2) Imagine their own death3) Focus on the loss of another, milestones
or major life events
4) Self-imposed isolation
5) Engagement
6) Who Am I
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Who Am I Exercise
Write down ten phrases that best describewho you are
Order them in terms of priority and
centrality to yourself
Cross out each description, beginning withthe least central one
Reflect
Write Your Own Obituary
Write Your Own Obituary during the next48 hours
Existential Theory ofPersonality
Uncomfortable with the term personality
Seems to be a fixed set of traits
Existence is an emerging and becoming process
Existence occurs not only for the individual but
Existence = being-in-the-world
Person and environment are an active unity
Reject dualism of mind-body, and experience andenvironment
Existential Theory ofPersonality
Being and world are inseparable because they arecreated by the individual
Phenomenologically, the world we relate to is ourown construction
We exist in relation to three levels in the world
Umwelt- equates to the physical and bio aspects
Mitwelt-social world or being-with-others
Eigenwelt-own world, the way we reflect upon,evaluate, and experience ourselves (being-for-oneself)
In the process of creating a healthy existence,we are faced with dilemma of choosing the bestway to be in-nature, with-others, and for-
ourselves Best alternative is to be authentic which is its own
reward
An authentic existence brings with it anopenness(awareness) to nature, to others, and toourselves. Also brings spontaneity with others with nofear that we might contradict what we pretend to be
Authentic existence brings integration with others, notconflict
Tillich talked about existential anxiety Awareness that we, at some unknown time, must die,
bein im lies nonbein
Conscious beings We make choices and are alone responsible
Meaninglessness is another contingency ofhuman existence that produces anxiety. Sourcesof meaning can disappear and be replaced
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The conclusion that ones existence is totally absurdcan be immobilizing
Our isolation or fundamental aloneness also causesanxiety We share experiences with others but can never be them
Death reflects our finiteness, accidents reflect ourlimits of power, anxiety over decisions, inadequacy ofour knowledge, the threat of meaninglessness, thefiniteness of our values, isolation, the finiteness of ourempathy, and rejection the finiteness of control overothers
Gestalt Therapy
Introduction
Developed by Frederick Fritz Perls &Laura Perls
Focused on the awareness of environmentin the thera eutic rocess
Organisms primary inborn motives aretoward self preservation and actualizationof the self
People have inner wisdom to change fortheir own well being
Concepts
Awareness is considered as the primarygoal and tool
The therapy focuses on building awareness
take responsibility and control of self
Believe that once client becomes aware of theNOW , they are in a position to own their individualchoices
Done through allowing the client the opportunity to
Resistance to awareness things thatimpairs awareness
The NOW
Emphasis on the here and now the present
Anxiety is described as gap between now and
Why questions lead to rationalizations andself deceptions and encourage resistance topresnt
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Unfinished business refers to
unexpressed feelings Persists till the individual faces and deals
Results into compulsive, self destructivebehaviors
Personality
The core of personality is seen as peeling
of individual layers of onion Five layers of onion
ony ayer reac ng o o ers nstereotypical and inauthentic ways
Phobic Layer avoiding the emotional painassociated with seeing ourselves the way wereally are
Impasse Layer the point where we are stuckin our own maturation
Implosive layer exposing our defenses andbeginning to make contact with our authenticselves
Explosive layer- releasing an enormousamount of energy as we let go of phony rolesand pretences
Therapeutic Process
Therapeutic Goals:
Move from environmental support to selfsupport
Attaining awareness of reality
Uses a series of EXPERIMENTS to create
awareness in the client
Experiments facilitate clients ability to deal
Experience the feelings associated withconflicts, ( not just talking about them)
Forms of experiments
Imagining a threatening future encounter
Setting up a dialogue between the clientand some significant person
Reliving in the present a particularly
profound early experience
Assuming the identity of ones father ormother in role playing
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Focusing on gestures, posture, and other
nonverbal signs of inner expression Carrying out a dialogue between
COUNSELOR SHOULD HAVEPERSONALLY EXPERIENCED THESEEXPERIENCES BEFORE DOING WITHCLIENTS
HELPS THE CLIENT IN THE HERE AND
NOW Uses the Gestalt process make client
,
Techniques
The dialogue exercise empty chair or chairexercise helps in building awareness of
various sides of conflicts
Substitute Phrase
Exaggeration helps to exaggerate then
emotions expressed by the client
Making the rounds
Guided fantasy
Playing the projection